By Peter Nelson

There’s something for everyone in the healthcare plans of the 2008 presidential candidates – except the nation’s 2.9 million registered nurses.
            A new report from AMN Healthcare, a leading health industry staffing company, shows that the candidates have not addressed the severe nursing shortage in the United States, even though many of their proposals would increase utilization of healthcare services.
            According to the American Association of Colleges of Nursing (AACN), the vacancy rate for nursing positions is 8.5 percent – a shortfall of 118,000 nurses. Writing in the Journal of the American Medical Association, Dr. Peter Buerhaus estimates that the deficit could grow to 400,000 nurses by 2020.
            “There is a critical connection between access to healthcare and the supply of physicians, nurses, and other medical professionals,” AMN President and Chief Executive Officer Susan Nowakowski told Reuters. “The candidates are suggesting positive healthcare reforms, but to be effective, their plans should take into account the need for more doctors and nurses.”
            Yet the AMN report, “Physician and Nurse Supply: The Missing Piece of the Puzzle,” shows that the candidates have left the nursing shortage out of their calculations for expanding healthcare coverage and improving the U.S. medical system.
            The remaining Republican contenders, Arizona Senator John McCain and former Arkansas Governor Mike Huckabee, make no mention of nurses or health care providers in either of their healthcare proposals.
            The healthcare plan of Illinois Senator Barack Obama, the leading candidate on the Democratic side, makes references to new funding for nursing schools and tuition assistance for nursing students that AMN describes as “unspecified.”
            New York Senator Hillary Rodham Clinton is more detailed. Her American Health Choices Plan would direct $300 million toward increasing nursing school recruiting and enrollment and earned her the endorsement of the American Nursing Association.
            The candidates are united, though, in their plans to increase access to health care in the United States. Without meeting the nursing shortfall, these expansion plans could have an adverse effect on the nation’s existing health care system.
            “If a near universal system of healthcare coverage were implemented, some 40 to 47 million more Americans would have access to healthcare than do so now,” the AMN study reports. “Should these newly insured Americans generate on average even one more physician visit per year, an additional 47 million patients would have to be absorbed by the nation’s limited supply of physicians and nurses.”
            An increase of that magnitude could exacerbate some of the pressures that already cause many new nurses to leave the profession ­– and add to the nursing shortage.
            In a recent survey conducted by the consulting firm PricewaterhouseCoopers, one third of nurses under age 30 said that they planned to quit their jobs, citing long hours and heavy workloads as reasons. The study confirmed that nurses were following through with their intentions to quit, finding that the job turnover rate for first-year registered nurses was 27.1 percent, as opposed to a profession-wide average of 8.4 percent.
            Writing in the Journal of the American Medical Association, Dr. Linda Aiken found that high turnover rates were correlated with poor patient care.
            “Failure to retain nurses contributes to avoidable patient deaths,” Aiken wrote in the report.
            Despite these challenges, students continue to apply to the nation’s nursing schools in record numbers. But faculty shortages mean that as many as 43,000 qualified applicants are turned away each year.
            Indeed, the AACN names faculty shortages as the chief source of the nursing shortage. Administrators at 64.8 percent of U.S. nursing schools told AACN researchers that faculty shortages were the reason that they could not enroll more students. In the sixteen states (and the District of Columbia) represented by the Southern Regional Board of Education, vacancy rates for nursing educators ran close to 12 percent.
            Nursing organizations like the AACN say that government funding could help offer higher salaries to nursing instructors, who typically earn far less than nurses in clinical settings. But they may have to wait until after the elections to see if the candidates plan to deliver real change to the nursing sector.